HIV Prevention and Alcohol (R34 Clinical Trials Optional) | RFA AA 21 017

Opportunity Information: Apply for RFA AA 21 017

The HIV Prevention and Alcohol (R34 Clinical Trials Optional) opportunity (RFA-AA-21-017) is a National Institutes of Health discretionary grant focused on strengthening and expanding the HIV prevention toolkit for people and communities affected by alcohol use. The central idea is that alcohol use, whether episodic (for example, binge drinking) or long-term, can increase HIV acquisition risk through behavioral pathways (such as reduced condom use, impaired decision-making, or decreased engagement with prevention services) and biological pathways (such as alcohol-related immune or mucosal changes and co-occurring sexually transmitted infections). This funding opportunity aims to support research that directly addresses those risks by developing, refining, and pilot-testing interventions and by integrating proven HIV prevention and treatment strategies in real-world settings where alcohol use is common or creates barriers to care.

This FOA emphasizes integrative, cross-cutting research that fits within the broader public health framework of reducing new HIV infections. Projects are expected to go beyond isolated, single-component approaches and instead connect HIV prevention with alcohol-focused strategies (and, when relevant, mental health and other substance use services). The R34 mechanism is typically used for early-stage, preparatory, or pilot work that helps establish feasibility, acceptability, preliminary efficacy, and implementation potential before moving to larger-scale effectiveness trials. Clinical trials are optional, meaning applicants can propose studies that include or do not include a clinical trial component, as long as the work fits the goals of intervention development, testing, and/or implementation planning.

The FOA identifies six primary research areas of interest, all tied to alcohol use and frequent comorbidities like mental health conditions and other substance use. First is PrEP utilization, which can include improving awareness, uptake, adherence, persistence, and service access for pre-exposure prophylaxis among alcohol-impacted populations, including addressing alcohol-related adherence barriers and clinic engagement challenges. Second is Treatment as Prevention (TasP), which focuses on strategies that improve HIV testing, linkage to care, antiretroviral therapy initiation, retention in care, and viral suppression, recognizing that alcohol use can disrupt each step of the HIV care continuum and therefore weaken TasP impact. Third is integration of preventive intervention strategies, encouraging models that combine HIV prevention with alcohol screening and treatment, behavioral interventions, harm reduction, sexual health services, or digital and community-based supports in coordinated ways rather than as separate programs.

The fourth area is prevention-related cross-cutting research, which generally refers to studies that produce broadly informative insights relevant across prevention approaches, such as identifying mechanisms of risk, tailoring interventions to specific alcohol use patterns, improving measurement of alcohol-related risk contexts, or understanding moderators and mediators that determine who benefits most from which intervention. Fifth is syndemic approaches, reflecting the reality that HIV risk often clusters with overlapping epidemics like alcohol misuse, depression, trauma, intimate partner violence, stigma, homelessness, and other drug use; projects in this area typically design or test interventions that address multiple interacting conditions together rather than treating them as independent issues. Sixth is implementation and operations research, which supports studying how to deliver and sustain effective interventions in routine practice, including questions about adoption, fidelity, cost, scalability, workforce needs, service workflows, and how different settings (clinics, community organizations, justice settings, shelters, bars/nightlife venues, mobile programs, telehealth platforms) can operationalize integrated HIV and alcohol-related services.

In practical terms, this opportunity supports work such as developing a new intervention that targets alcohol-related sexual risk, adapting an evidence-based PrEP support program for people with heavy drinking patterns, integrating alcohol screening and brief intervention into HIV prevention clinics, testing strategies to maintain PrEP adherence during periods of increased drinking, or piloting service delivery models that link people to both substance use treatment and HIV prevention. The FOA is also designed to encourage research in diverse populations and settings, including groups disproportionately affected by HIV and alcohol-related harms, and settings where prevention gaps remain due to structural barriers.

Eligibility is broad. In addition to common applicants like state and local governments, public and private institutions of higher education, tribal governments (federally recognized), tribal organizations (including those other than federally recognized tribal governments), public housing authorities/Indian housing authorities, and a range of nonprofit and for-profit entities (including small businesses), the FOA explicitly highlights additional eligible applicants such as faith-based or community-based organizations, U.S. territories or possessions, regional organizations, and non-U.S. entities (foreign organizations). It also calls out several institution types, including Historically Black Colleges and Universities (HBCUs), Hispanic-serving Institutions, Tribally Controlled Colleges and Universities (TCCUs), Alaska Native and Native Hawaiian Serving Institutions, and Asian American Native American Pacific Islander Serving Institutions (AANAPISIs). This emphasis signals an interest in widening participation and ensuring research reflects the communities most impacted.

Key administrative details included in the source data are that the agency is NIH, the activity category is Health, the funding instrument is a grant, and the CFDA number is 93.273. The opportunity listed an award ceiling of $450,000. The original closing date was December 16, 2021, and the FOA was created on August 20, 2021. Overall, the program is aimed at generating actionable, scalable prevention solutions that explicitly account for alcohol use and its common co-occurring conditions, with the end goal of reducing new HIV infections by improving both prevention uptake (like PrEP) and treatment-based prevention outcomes (like sustained viral suppression).

• The National Institutes of Health in the health sector is offering a public funding opportunity titled "HIV Prevention and Alcohol (R34 Clinical Trials Optional)" and is now available to receive applicants.
• Interested and eligible applicants and submit their applications by referencing the CFDA number(s): 93.273.
• This funding opportunity was created on 2021-08-20.
• Applicants must submit their applications by 2021-12-16. (Agency may still review applications by suitable applicants for the remaining/unused allocated funding in 2026.)
• Each selected applicant is eligible to receive up to $450,000.00 in funding.
• Eligible applicants include: State governments, County governments, City or township governments, Special district governments, Independent school districts, Public and State controlled institutions of higher education, Native American tribal governments (Federally recognized), Public housing authorities/Indian housing authorities, Native American tribal organizations (other than Federally recognized tribal governments), Nonprofits having a 501 (c) (3) status with the IRS, other than institutions of higher education, Nonprofits that do not have a 501 (c) (3) status with the IRS, other than institutions of higher education, Private institutions of higher education, For-profit organizations other than small businesses, Small businesses, Others.

Apply for RFA AA 21 017

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